Psychiatric medications, science, marketing, psychiatry in general, and occasionally clinical psychology. Questioning the role of key opinion leaders and the use of "science" to promote commercial ends rather than the needs of people with mental health concerns.

Wednesday, June 06, 2007

Sorry for my delay in jumping on the latest New York Times story (courtesy of Gardiner Harris and Janet Roberts) detailing how drug companies hire doctors to carry out clinical trials despite their questionable backgrounds.

Much discussion of this sordid tale has already occurred at such outlets as:

Most of what I wanted to say has already been said by the above writers.However, I have a bit to add.

Quote of the Week: Hell, this might be quote of the year, really.In the out of touch with real people category, I submit, from the New York Times [emphases added]…

Dr. Ronald Hardrict, a psychiatrist from Minneapolis who pleaded guilty to Medicaid fraud. In 2004 and 2005, he collected more than $63,000 in marketing payments from seven drug makers. In an interview, Dr. Hardrict said it was “insulting” and “ridiculous” to suggest that income from drug markers might influence doctors’ prescribing habits. [and on to the quote of the week…]

“I bought the Mercedes because it has air bags, and I use Risperdal because it works,” Dr. Hardrict said, referring to an antipsychotic medicine for schizophrenia. Johnson & Johnson, the maker of Risperdal, paid Dr. Hardrict more than $30,000 in 2003 and 2004.

SNIP

Asked why other drug makers continue to hire him despite a fraud conviction, Dr. Hardrict responded with an email message stating only, “I will pray for you daily.”

I think I speak on behalf of my readers when I say that we’ll likewise be praying for Dr. Hardrict and his Mercedes.

Are You Faruk-in’ Kidding Me?Sometimes a person’s name makes for a catchy headline, so I thank Dr. Faruk Abuzzahab for that.I was reading through the Minnesota Board of Medical Practice’s lengthy document that detailed the alleged misdeeds which resulted in a suspension of Abuzzahab’s medical license.Very interesting document.

We all make mistakes.Occasionally we make large mistakes.That’s okay.But a pattern of making similar mistakes, errors that lead to significant anguish and, in some instances, may contribute to the death of people – that’s not okay.I’ll run a trio of quotes from the report…

In a number of cases (including but not limited to patients #35, #36, and #40, for example), Respondent [Abuzzahab] enrolled psychiatrically disturbed and vulnerable patients into investigational drug studies without ensuring that they met the eligibility criteria to be in the study and then kept them in the study after their conditions deteriorated.

Respondent's documentation regarding patient #36's participation in the sertindole study differed from the staff's documentation. While Respondent documented at more than one point that patient #36 was much improved and mildly ill, staff consistently noted her deterioration throughout the study. It was also documented that patient #36 made several references indicating that she did not want to take the medications. Respondent failed to document his rationale for continuing investigational medication under these circumstances.

The pattern that emerges from Respondent’s treatment of the approximately 46 patients at issue in the contested case proceedings is that he regularly fails to substantiate his diagnoses, monitor whether the combination of drugs is appropriate for the symptoms being treated and is having the desired effect, and evaluate whether the benefit outweighs the adverse effects noted in the chart.This fundamental failure shows a reckless, if not willful, disregard of the patients’ welfare, exposes the patients to an unnecessary risk of harm and contributes to their deterioration while under his care.

A few years back, here’s a couple slices of what Morris Goldman from the University of Chicago’s psychiatry department had to say about the drug trial research field and about Abuzzahab, whom he investigated:

There are ''people drawn into this field because they are interested in dollars,'' Goldman added. ''They are very profit-conscious. And that combination of a lot of money, plus the added ethical dilemma you face in human research, that is a bad combination. And there are particular risks with psychiatric patients, with the whole issue of informed consent. It can really go wrong.''

''He [Abuzzahab] would have the patient's diagnosis called one thing in the regular chart, and then the person would be put on a drug study and the person's diagnosis would be called something else to fit the criteria''

Journalist Robert Whitaker (in the Boston Globe) said the following about Abuzzahab, and the transcript from the Board of Medical Practice (pgs. 21-22) appears to back his reporting.

In another instance, the psychiatrist took a woman off clozapine, a newly approved drug that had led her to make a remarkable recovery, and enrolled her in a drug trial. The woman had previously spent 13 years as an inpatient at a psychiatric institution, but while on clozapine she had been able to go into the community and even hold a job. One day she approached Abuzzahab with questions about clozapine's side effects; he immediately stopped the drug that had helped her so much and put her into an olanzapine trial. She deteriorated until she found her way to another physician, who put her back on clozapine.

The Payout: Two disclaimers first: 1) I cannot verify the accuracy of the following information, though I have no reason to doubt its veracity. 2) I am not disclosing the source of the information, as I believe it could lead to untoward consequences in the wrong hands.

I found that Abuzzahab lives (or recently lived in) a house described in the following manner:

Built in 1931. The structure is a 2 1/2 story, 7569 square foot, eight bedroom, six bathroom, 17 room, single family dwelling, with a partially finished basement.

I found that a home on his street recently sold for about $2.7 million dollars.The other home appears to be significantly smaller than Abuzzahab’s pad – I’m no realtor, but it my relatively uninformed guess is that Abuzzahab is living large in a three to four million dollar crib.Not bad.Who says forging records and prescribing inappropriately does not have its rewards?

My Take: Granted, the NYT report on Abuzzahab paints a very negative picture, as does the Boston Globe article, as does the Minnesota Board of Medical Practice document.Certainly, all of the above selectively examined negative evidence, and did not have a chance to see the patients who had benefited under his care.That being said, there seems to be more than enough evidence to indicate that there is no way Abuzzahab should ever be involved in clinical research again, and it is a bit scary to me that he is practicing medicine, though perhaps he has reformed his ways.

He’s also listed as an instructor for the University of Minnesota as recently as 2005.I’m not sure if he’s still employed at the university, but it seems quite odd that they would select him as an instructor.

For all I know, Dr. Abuzzahab is the nicest guy in the world.I wish him no ill. We all make mistakes, but there are some missteps, especially when they happen repeatedly, that should disqualify people from teaching university students, conducting research on the latest drugs, and caring for patients.

9 comments:

Firstly, I want to say that blogs like yours and Furious Seasons do a fantastic and very necessary job exposing the corrupt practices and scientific slights-of-hand of pharmaceutical companies. Good on you and keep at it.

However, there's a missing link between the perfidy of the pharmas and the consequences it has for patients, and that it is of course the medical profession. Faruk, is he fuckin' far-out, no I don't think so.

Morris Goldman points out that "people are drawn into this field because they are interested in dollars... and the combination of a lot of money, plus the added ethical dilemma you face in human research, that is a bad combination. And there are particular risks with psychiatric patients, with the whole issue of informed consent. It can really go wrong." That's fifty-five words, practically two stanzas, to say "some psychiatrists are sociopaths who don't give a toss about ethics or informed consent." But he won't just come out and say it, will he?

When did psychiatry as a while get let off the hook? Of course, not all psychiatrists are accepting bribes to mistreat their patients in the name of 'research', they still may base their practice on that 'research', accepting it uncritically. Why all the astonishment at the behaviour of this Faruk-head who just happened to be the one of the unlucky few who got caught?

Anyone who buys a car for it's airbags is an idiot. 200MPH netting in the face has killed people [women and kids]5 feet tall and under.

As a spokes person for airbag safety, including gaining on/off switches added, and public schools to stop transporting kids in the front seat of cars, covered by all media sources possible--maybe it's time for me to take psych medications, and primarily anti psychotics to the mattresses with media. Sorry for the soapbox, but we all wonder why voices are not large enough to be read on blogs?

People don't read blogs like they watch TV. Referring to your other post--all of the best bloggers you listed that write w/out pay?

That looks like a pretty well-informed panel for CNN. Squeaky wheels get the grease, and lord knows if I could get in the news for airbags for weeks, [on camera and in print]--you all certainly should be able to get a panel somewhere. Bring me along as the "human interest story" along with my daughter. Nothing will change sitting at a keyboard typing.

Dr. Abuzzahab is one of the best doctors I've met, in fact he saved my life. He is one of the nicest people I know and I was very surprised to find this article about him. It's intersting that this didn't mention any of the very beneficial and life saving studies he has done.

Hmmm. How about you tell us more about the "life saving" studies? You can read the linked report in the post about some instances where "life saving" doesn't exactly describe his practice; please enlighten us with more info about his good practices.

Well, I was actually a patient of Dr. Abuzzahab's. Before I met him, seven previous doctors had misdiagnosed my condition over a period of two years. Abuzzahab nailed the diagnosis (which, by the way, wasn't a mental illness at all - it was a serious but obscure viral infection). He worked quickly and effective and compassionately.

One very important fact that the articles omitted is this: Dr. Abuzzahab typically treats a lot of patients who don't fit into simple, easy diagnostic categories. The patients that other doctors can help end up at his clinical because he is known as a highly skilled diagnostician.

I have no illusions about the allegations made by the articles. But Dr. Abuzzahab simply isn't the person you have tried to describe, and he probably saved my life when many, many other doctors got it completely wrong.

I am an MD and a patient of Dr Abuzzahab too.He is definitely the best psychiatrist in Minneapolis Twincities Minnesota.I say that because could not be stabilized more than few months at one psychiatrist before 2000.she has been with Dr Abuzzahab since 2000. While other psychiatrists go into Safe Mode if faced by unexpected consequences or unresponding treatments, Dr Abuzzahab is the most one brave enough to stay with the patient to help the patient through the worst of Psychiatrist scenarios.Why should not he be?He earned his MD degree way before most of those critics ( including MDs were born(1950 MD from American U ).He also has PhD in Pharmacology in addition to his MD and he is expert in some fields. So it is natural he would be recruited by pharmaceutical companies, because his expertise and advice help them weed out bad medications. You need a really good and brave doctor to do the job.

I am a former patient of Dr Faruk and would like to say he is a good doctor and always remembers me on the phone, even though I frequently go 2-3 months without talking to him. He is overall a very friendly person, even though he is aware that I won't be going to his office anymore (changed jobs/health insurance).

After reading this, I am not all too surprised with the allegations. If I remember correctly the name of his clinic was something like "psycho pharmacological consultants" it might be different now.

Anyways, you have to know when you go to a place like that the guy in the white coat is going to believe in the "power of medicine" including the continual research/development of drugs and medicine.

Also he is a pretty old man and has probably spent alot of time in the pharma industry. He's even worked at places like John Hopkins, so he's not just some hack psych just giving people pills for free. Obviously there's cases where he made the wrong choices but who hasn't.

As a former patient of Faruk's, let me say that it is not my impression at all that Dr. Abuzzahab is or has been motivated by money. In fact it has always seemed to me that his primary interest is medicine itself, and novel and sometimes unusual approaches to psychopharmacology.

While a patient of Faruk's (2 years) I was aware that restrictions of sorts had been placed on his prescribing abilities. Although I knew this, I did feel comfortable with him making medical decisions for and with me.

Dr. Abuzzahab is indeed a very well educated man if a bit scattered mostly. His papers were always in disarray and he could barely remember where he had placed his Rx pads but at the same time there was a wittiness and enthusiasm for medicine and his patients that is far greater than what one might find in an ordinary prescriber.

I need to also say Faruk expressed deep concern over regimens where polypharmacy is and was involved. He was a major factor in DISSUADING me from beginning trials of potentially risky neuroleptics and would spend a good deal of time explaining the risks associated with medicines.

I cannot condemn him at all. I am sure he has made mistakes. Let us not judge only by these mistakes. It is possible Faruk himself suffers from some sort of memory condition.. this is something I considered when noticing his candor and behaviours as a patient.

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About Me

I'm an academic with a respectable amount of clinical experience and no drug industry funding. Given my lack of time, don't expect multiple daily updates. Certain things about clinical psychology, the drug industry, psychiatry, and academics drive me nuts, and you'll probably pick up on these pet peeves before long...